H.R.1247 -- Improving Veterans Access to Quality Care Act of 2015 The Improving Veterans Access to Care Act (H.R.1247) sponsored by Representatives Sam Graves (R-MO) and Jan Schakowsky (D-IL) (hereinafter alternatively "the Act"), is intended to reduce existing delays in healthcare delivery being experienced by the Veterans Health Administration (VHA) (Smith, 2015). The provisions of the Act would extend full practice authority to certain advanced practice registered nurses (APRNs), including nurse midwives, clinical nurse specialists, nurse practitioners, and certified registered nurse anesthetists in Department of Veterans Affairs (VA) health care facilities regardless of the state in which they are located. To date, the American Association of Nurse Anesthetists (AANA), the Association of Veterans Affairs Nurse Anesthetists (AVANA), more than 50 nursing organizations, as well as veterans service organizations, the Military Officers Association of America, the Air Force Sergeants Association, the American Association of Retired Persons (AARP) together with more than 75 members of Congress have all supported this legislative initiative (VHA APRN full practice authority, 2016). Notwithstanding this widespread support, however, some critics maintain that extending full practice authority to APRNs will diminished the quality of services provided veteran patients at VA health care facilities while others argue that that decision to extend full practice authority should reside at the state level. To determine the facts, this policy brief analysis provides a summary of the arguments in support of and against the Act, relevant background information, an evaluation of alternatives and a recommendation for action. In addition, a one-page policy brief is also provided that summarizes the foregoing information for ease of reference.

A summary of the issue

At present, advanced practice registered nurses (APRNs) practicing in VH A facilities across the country remain subject to the respective laws of the state in which the health care facility is located (ANA urges support for bill to increase veterans' access to APRNs' services, 2015). Although some states have already extended full practice authority to APRNs, other states continue to restrict their scope of practice in ways that detract from the ability of the VHA to delivery timely and efficacious health care services (ANA urges support, 2015). In response to this problem, the Act extends full practice authority to (APRNs) working in all VHA facilities regardless of the state laws that are in place. In this context, "full practice authority" means "allowing APRNs to practice to the full extent of their

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Background information

Advanced practice registered nurses are registered nurses who possess a master's or doctorate degree together with relevant clinical experience and who typically specialize in one of the four main categories of APRNs: (a) clinical care; (b) midwifery, (c) primary care (nurse practitioner) and (d) anesthesia (Hinkley, 2013). In general, APRNs are empowered with many of the same practice authorities as physicians, including the ability to diagnose and treat illnesses and, depending on the jurisdiction involved, to prescribe medications in some jurisdictions (Hinkley, 2013). Although some states currently permit APRNs to practice independently within certain parameters or with complete autonomy, others still require APRNs to practice under the supervision of in collaboration with physicians (Hinkley, 2013). These three varying levels of practice authority are summarized in Table 1 below.

Table 1

Three levels of APRN practice authority

Practice Level

Description

Independent

No requirement for a written collaborative agreement, no supervision, no conditions for practice.

Not Independent

A written agreement exists that specifies scope of practice and medical acts allowed with or without a general supervision requirement by a MD, DO, DDS or podiatrist; or direct supervision required in the presence of a licensed, MD, DO, DDS or podiatrist with or without a written practice agreement.

Prescriptive Authority

An APRN is authorized to prescribe pharmacologic and non-pharmacologic therapies beyond the perioperative and periprocedural periods.

Source: APRN roles recognized, 2016

Supporters of the Act maintain that the authorization of full practice authority to the four categories of APRNs (i.e., nurse practitioners, certified nurse-midwives, clinical nurse specialists and certified registered nurse anesthetists) can help the VHA maximize the utility of these valuable health care professionals to reduce wait times for treatment (ANA urges support, 2015). Moreover, the Act is also congruent with recommendations provided by the Institute of Medicine'sreport, "The Future of Nursing: Leading Change, Advancing Health," as well as other initiatives being contemplated by the VHA to improve the timeliness and quality of health care services delivered to veteran patients (ANA urges support, 2016). In addition, the extension of full practice authority to the four categories of APRNs would make the VHA care model consistent with the existing models…